A longitudinal analysis of overall and telehealth addiction treatment utilization three years after pandemic-related...

Studies have identified differences by patient characteristics in addiction treatment utilization in the early COVID-19 pandemic period, yet an understanding of longitudinal changes in utilization patterns remains unclear. We examined treatment utilization trends over three years post-pandemic, with a particular focus on differences by age and race and ethnicity.

Using electronic health record data, this retrospective cohort study examined overall and telehealth addiction treatment initiation and engagement 3 years pre- and 3 years post-pandemic (3/16/2020) following identification of 170,618 episodes involving problematic substance use among 124,413 adults in a large, integrated Northern California health system. Interrupted time series models were fit to examine annual utilization rates during pre- and post-pandemic periods (3/1/2017-1/15/2020 and 5/17/2020-2/28/2023, respectively), and level- and trend-changes in utilization from pre- to post-pandemic, overall and by age group and race and ethnicity.

Overall treatment initiation decreased from 27.0% to 24.2% during the pre-pandemic period by approximately 2% annually (RR [95% CI] = 0.98 [0.96, 0.99]), increased by 6% after the onset of the pandemic (1.06 [1.03, 1.10]), and then decreased by 2% annually in the post-pandemic period to 23.0% (0.98 [0.79, 0.99]). Telehealth initiation increased from 1.9% to 2.6% during the pre-pandemic period by 12% annually (RR [95% CI] = 1.12 [1.06, 1.19]), increased five-fold immediately after pandemic onset (RR [95% CI] = 5.14 [4.62, 5.72]), and then decreased by 10% annually (RR [95% CI] = 0.90 [0.88, 0.92]). Overall and telehealth engagement followed similar patterns. Pre- to post-pandemic trends in utilization varied by age group and slightly by race and ethnicity, which may have been primarily driven by initial increases in utilization at the onset of the pandemic.

Following immediate increases in treatment initiation and engagement during the pandemic, utilization via telehealth decreased slightly over time. Availability of telehealth was not associated with increased or sustained utilization over time. Despite some variation in trends over time by age group and race and ethnicity, we did not find strong evidence of differences across groups.